At last, doctors (and patients) are recognising the importance of testosterone.
It is not of course a male hormone, as it is present in the normal young
female in even higher concentration than oestradiol. But men, hopefully,
have more testosterone on board than women. There is a female androgen
deficiency syndrome (FADS) which occurs with failing ovaries and certainly
after bilateral oophorectomy which manifests itself with loss of energy,
loss of libido, tiredness, loss of self-confidence and headaches. These
women respond very well to testosterone. Although testosterone is available
in tablets, IM injections, patches and gels, these are not licensed for
women and the only way in this country to deliver testosterone is by an
implant. For convenience, it seems sensible to insert an oestradiol pellet
at the same time as testosterone. The benefits of oestradiol and testosterone
are particularly apparent in patients after hysterectomy and bilateral
salpingo-oophorectomy because a) they need replacement of the missing
ovarian androgens and b) HRT should be straightforward as there is no
bleeding and no need for the cyclical progestogen with its PMS type side-effects.
Our own data of 200 such patients shows a continuation rate of 96% at
5 years and 88% at 10 years. This brings us back to the initial statement
about continuation rates because women feel better.